Perinatologist | Goddess in Progress

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Hospital day, 33w6d

By Goddess in Progress · Comments (1)· July 19th, 2007

An interesting day, indeed, at the hospital. Today was a growth check with the ultrasound, in addition to the biophysical profile. Both babies passed the BPP, though we had to poke little boy to get him to wake up and move around for us. Weight estimates were encouraging, but interesting… Baby girl appears to have had a bit of a spurt and put on a full pound to reach 4lb4oz. Baby boy actually slowed down and gained only 10oz to reach 5lb3oz. Of course, these are estimates, and can arguably be further off the bigger (and more crowded) the babies get. But still, very encouraging that little miss continues to grow. An unusual twist, however, that her brother is slowing down. He also appears to have a bit less fluid than she does. As the peri said, it’s not as worrisome as it would be if little girl was the one with less fluid, but something to keep an eye on, nonetheless. Non-stress test was just fine, and as of next week, I’m going to actually go in TWICE every week. Good thing I’m done working!

The craziest part of the visit, however, was our discussion of when to deliver. First of all, if I go into labor spontaneously anytime tomorrow or later, they will not attempt to stop me. If it were to peter out on its own, they wouldn’t try to restart it, but they won’t stop me. OK. Wow. And then she said, “so, when do you think we should have these babies? I’m thinking 36-37 weeks.” Whoa!! Used to be 38, then 37-38… now 36? Holy crap! That’s two weeks!!

Basically, the plan is this: I’ll have my twice-per-week BPP and NST. If anything looks concerning, they might decide it’s a good day for a birthday. My next growth check will be in two weeks (August 1, to be precise). If either one of their growth has slowed or stopped? Birthday time. If growth is still good, they’ll schedule me for induction or c-section at right about 37 weeks.

WOW! I can barely wrap my mind around it. Three weeks at the most, possibly two or less. I’m pretty darn excited, but mostly it’s just not sinking in at all.

I’m off to my OB’s office shortly, where we definitely need to have a discussion about delivery method. Baby boy seems to have really taken over at the baby A position, and is head down, so vaginal delivery is an option on the table. We shall see.

Oh, and my blood pressure seemed to be creeping up at the NST today. We’ll see if that issue proves to be the dark horse that determines birthday time. I’ll update after the OB’s office if there are any interesting developments.

OB Update
After talking to my OB, she’s totally cool with me going directly for the c-section. She seemed to think it was probably a good idea in my case. If I change my mind and/or they both flip to vertex, I’m welcome to try for vaginal (if they don’t flip, then only if she’s the one on call, because she’ll do a breech extraction of twin B). But otherwise, she’s going to schedule my c-section for right about 37 weeks! To be moved up if things change, of course. Holy crap!!

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Categories : Hospital, OB Appointments, Pregnancy, Ultrasounds

Tags : blood pressure, c-section, discordant growth, NST/BPP, perinatologist, preterm labor

Hospital Day, 31w6d

By Goddess in Progress · Comments (0)· July 5th, 2007

Today was the usual ultrasound, non-stress-test routine at the hospital. The ultrasound went pretty well. While the size discrepancy between the twins is widening somewhat, my little girl is still growing. The past several checks, she had gone up just about a half pound (8 oz) over the course of two weeks. This time, she was up 12 oz to 3lb, 4oz. Not an enormous growth spurt, I suppose, but a good thing nonetheless. Her brother keeps packing it on, putting on yet another 16 oz to reach 4lb, 9oz. He is still vertex, she is still breech, and they are both way the heck up in my ribcage. As I am nearly 32 weeks, today also marked my last cervix check via ultrasound. Just like at my very first appointment with the perinatologist, 14 weeks ago, Iron Cervix is holding steady at an absolutely ridiculous 4.3cm. That’s kind of insane for even a singleton pregnancy at this point. But it appears my occasional contractions, combined with a whopping 7lb, 13oz of baby, is having absolutely no effect on my cervix. Guess they’re not intending to make their entrance any time soon. Oh, and another good day for the biophysical profile: plenty of fluid, practicing breathing, good movement, etc.

If I caught the notes correctly, little girl is trailing off in the percentiles race again, but is not yet what you would call growth-restricted. So, we’ll keep on plugging. My peri told me they’d deliver me under any of the following circumstances: baby girl stops growing or falls below the 10th percentile, either of them start to do poorly on the biophysical profile or non-stress tests, or I reach 37-38 weeks. Certainly there are other potential complications out there, but those are the three main things she’s looking for. Depending on the next growth check in two weeks, they also might have me come in for the BPP and NST twice per week instead of once. Presumably that’s if she still isn’t growing all that much and they’ll want to keep an eye on her just in case she starts to show any distress.

Today’s non-stress test also went just fine. Took a while to get them on the monitor, because they kept moving around and kicking the sensors. But eventually we got some good tracking, and the nurse pronounced herself happy with the results. Sounds good to me! My blood pressure seems to be creeping up just a little, but we’ll see how it looks at next week’s OB checkup.

That’s the news that’s fit to print from here. We’re off to a breastfeeding class this evening, which is our final prenatal class. I can’t believe we’re already here!

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Categories : Hospital, Pregnancy, Ultrasounds

Tags : cervical length, discordant growth, NST/BPP, perinatologist

Day at the hospital, 29w5d

By Goddess in Progress · Comments (2)· June 21st, 2007

Yesterday afternoon was my usual ultrasound with the perinatologist. My mom was in town, so she got to come with us. She’d never had an ultrasound with me or my brother, so it was neat for her to be able to see everything.

Both babies look good, moving a lot, plenty of fluid, all of that good stuff. And for the first time, they are both head-down (I thought my belly looked different…). Baby girl put on another 7 oz to measure 2lb8oz, still hanging out around the 28th percentile. Her brother, on the other hand, put on 15 oz, up now to a whopping 3lb9oz. So not only is there a full pound difference between them, but he has shoved her out of her “baby A” position. She is now relegated to Baby B status.

Given her continued peanut-ness, my perinatologist decided to err on the side of caution and start my weekly non-stress tests now. So after leaving briefly to get some lunch, I headed back into Labor & Delivery to be hooked up to monitors for an hour. Both babies were tracking just perfectly. They were very active for a large portion of the time (probably helps that I’d just eaten a very carb-heavy lunch), and their heartrates were very good. Interestingly, though, I was having somewhat frequent contractions! It was not a new sensation, but one that I hadn’t been entirely sure was a contraction. Well, now I know. The nurse, a very nice Irish woman named Mary, had me drink some extra water and they spaced out a bit further. And since I’d just had my cervix checked and it was still a good 4cm, they decided it was not an issue of major concern. She just advised me to continue taking it easy, and pretty much to drink as much water as I could manage. (Yes, lie on my left side and drink lots of water.)

So, I now have an ultrasound, followed by a non-stress test, every week from now until August 15 (the peri pretty much promised I wouldn’t go past then, thankfully). That’s at least two hours in the hospital, and that’s if nothing goes wrong in between appointments. Oh, and that’s not including my usual OB appointments. We’ll see how long I manage to keep working…

It’s hard not to worry about my little girl, and how very little she is. But she technically isn’t “growth-restricted,” since that’s a designation for being under the 10th percentile, and she keeps plugging along and growing, which is good. I’m just a little worried that her enormous brother is going to take up all of the space and cause problems for her. But for now, she’s showing no signs of distress, and though her movements are frequently more subtle than her brother’s, she’s still kicking away.

We’ll see what next week brings.

Comments (2)

Categories : Hospital, Pregnancy, Ultrasounds

Tags : contractions, discordant growth, hydration, NST/BPP, perinatologist

Ultrasound, 27w6d

By Goddess in Progress · Comments (0)· June 7th, 2007

Another day, another doctor’s appointment!

Today was a combo, 2-hour glucose test and a regular perinatologist ultrasound and checkup. Both of them take place at my hospital, so I was glad to be able to combine the trip.

The glucose test went fine, as far as my experience goes. They only had me do a fasting and a 2-hour draw, with some glucose drink in between. The phlebotomist had to take it from the back of my right hand both times, but she was able to get it on the first stick each time, so I can’t really complain. I should get the results tomorrow.

In the middle of all of that, I went up to the second floor for the ultrasound. Both babies have flipped! Now, baby girl A is breech, and baby boy B is vertex for the first time. They both grew well over the last two weeks. Little peanut A put on another 8 oz to measure 2lbs 1oz, about the same percentile as last time (~27%). Her brother is packing it on, adding 11 oz to be 2lbs 10oz! I’m not sure of his percentile. It seems that she’s just plain littler than her brother, but since they’re both growing well and everything else looks good, no one seems worried. They both have good amounts of fluid (hence their flipping), and both of their heart rates were about 148.

After describing some of the feelings I’ve been having in my belly, it does appear that I’m having the occasional Braxton Hicks contraction, which my doctor said was definitely to be expected at this point. The good part is that it seems to be having little to no effect on my cervix, which is still measuring 3.8-4cm. Excellent.

I’m really feeling very good after today’s ultrasound. Things are moving along nicely, the babies look great, and I’m showing no signs of early labor. This really is putting my mind at ease for the time being. Certainly, I’ll freak out again, but so far, so good.

I also learned that, starting at 32 weeks, I should expect have weekly non-stress tests at my OB’s office. If fluid or growth gives any concern before then, they could start them earlier, but I should expect it at 32 weeks. I also asked about vaginal vs. c-section birth (I really don’t care which one I have, though some people have strong feelings one way or the other). She said she would not recommend me being allowed to try for a vaginal birth unless both babies were head-down at the time. If baby A was the larger of the two, they might let me try even if B was breech, but since she’s little, they both have to be vertex to even try. The likelihood, therefore, is for the c-section. No problem by me.

Back later with photos!

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Categories : Hospital, Pregnancy, Ultrasounds

Tags : blood draw, gestational diabetes, perinatologist

Ultrasound, 25w6d

By Goddess in Progress · Comments (1)· May 24th, 2007

Had a good visit with the perinatologist today. Hooray!

Both babies put on eight ounces since the last visit. While baby girl A is still smaller than her brother, she put on a significant amount of weight and went from about the 17th percentile up to the 27th percentile! Baby boy B also went up from the 48th percentile to the 52nd. So while they’re still “discordant” as far as their weights go, they’re both going up, so that’s definitely a good thing. Heartbeats were good, baby boy’s kidneys were holding relatively steady. Still a little larger than we’d like, but clearly working. Oh, and as I suspected, baby A has turned back head-down. B is still firmly breech.

A couple of good pictures today, too!
Little miss is sort of bending her head back. Not sure what the big white shape is in the upper left, but I suspect it might be her brother’s foot. It was the best shot we could get, since her head is nice and low right now.

Baby boy, however, had no trouble showing off his profile. Of course, I suppose it helps that his head is practically up near my ribs.

And, just for fun, the ultrasound tech even busted out the 3D! The ones we tried to get of our girl looked like a big blob of nothing. But baby boy B was ready for his 3 dimensional debut. How’s that for cool?

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Categories : Pregnancy, Ultrasounds

Tags : 3D ultrasound, discordant growth, perinatologist

Ultrasound, 23w6d

By Goddess in Progress · Comments (3)· May 10th, 2007

A mixed bag at the perinatologist’s office today.

The good news is that my cervix remains shut like an iron fist. Despite the beating the twins insist on giving it every day, it’s still greater than four centimeters. This is a very good thing. My husband suggested it might be a whole new kind of kung fu (Iron Cervix!), but we’ll have to see if that catches on.

Both babies are doing well, heartrates are good, fluid levels are good, no one seems to be in any distress. My baby girl A, though, is still quite a little peanut. She’s very active, which is a good thing, and everything looks to be developing well, but she’s growing slowly. She put on about 5 oz. since our last visit, making her only 1 lb 1 oz., which is about the 17-18th percentile for babies of her gestational age. Her brother, baby boy B, put on 8 oz to become 1 lb 7 oz, and is in the 48th percentile. He’s measuring a day ahead, gestationally speaking, and she’s measuring just over a week and a half behind. Not horrible, but not encouraging, either. I’m now going to be seeing the perinatologist every two weeks instead of 3-4, to keep tabs on her progress. If we get to 28 weeks and she isn’t really catching up, they’ll likely start giving me steroid shots to speed up lung development in case they need to come early. But as long as she keeps growing (even if it isn’t as fast as I’d like) and fluid levels are good and she isn’t in distress, we’ll just keep cooking as long as possible.

Baby boy B’s kidney didn’t improve from last week, and in fact has now slightly more fluid (though he’s also growing larger, so it’s not all bad), and is something we’ll still keep an eye on.

I like my perinatologist a lot, and I like that she’s really encouraging and not an alarmist. Yes, she said there may come a point where they want to hit me up with some steroids to help with lung development in case they need to come early, etc. But I like that she calmly says these things and then moves on to something more encouraging. I don’t want her to pretend everything is peachy when it’s not, but I also don’t want her to freak me out more than necessary. She strikes a good balance, I think.

That’s the update from here. I’ll try to post pictures when I get home tonight. Got a few halfway decent face shots, though no 3D. Maybe another time.

Edited, finally. Here are the pictures!
A face shot of baby A:

And baby B with his arm in front of his face. It’s like one of those pictures at the mall. If you stare at it in just the right way, it looks like a sailboat. I swear.

We also got a good picture of the double-breech… two heads are better than one!

Comments (3)

Categories : Pregnancy, Ultrasounds

Tags : discordant growth, perinatologist

Ultrasound, 20w6d

By Goddess in Progress · Comments (2)· April 20th, 2007

Had my appointment with the perinatologist this morning, and things looked pretty good. I always enjoy going for the ultrasounds, getting a peek at the babies. Baby A (girl) has flipped over and is now breech. She was moving around a TON, actually making it a little difficult for the tech to get all of the measurements she wanted. Guess I should lay off the OJ before ultrasounds now. Baby B (boy) is also breech, as he was last time. He was moving a bit, too, but not quite as wildly as his sister. When she went to check my cervix, though, we caught one of them in the act: kicking me in the bladder! Mommy does not enjoy this! And now that they’re both feet-down, they can pretty much take turns doing so. Nice. But my cervix is still nice and long (despite the pummeling it’s taking from one or both of the babies), so that’s a very good thing.

Spoke with the peri after the ultrasound, and she said there were two things she wanted to keep an eye on, but that she isn’t too concerned about just yet. The first is that our girl is measuring 3 ounces smaller than her brother (12oz vs. 15oz). While this could be just fine, she could just be a smaller baby, we want to make sure she continues to grow well and the discrepancy doesn’t grow larger. We’ll check again at my appointment three weeks from now. If progress is good, we’ll stay on the 3-4 week rotation with appointments. If not, I’ll start going more like every 1 or 2 weeks. If it gets worse, there could be bedrest, steroid shots, etc. But for now, it’s just something to keep an eye on.

The other small issue is with our boy. One of his kidneys has a small amount more fluid in it than is desirable. Apparently the maximum on the “normal” scale is 4mm, and one of his is more like 4.3mm. This is an issue more commonly seen in boys, for unknown reasons. Could be a very minor issue that will resolve itself, could grow into a larger issue (most concerning if it is 7mm to over 10mm). Unlikely to cause permanent damage, but something to be aware of. It’s also a soft marker for Down’s Syndrome, but I’ve had no other markers or any other risk factors, so my doctor really doesn’t think that’s the issue. But she wanted to mention it, since she figured I’d go looking up “fluid in kidneys” on the internet and find links to Down’s and worry she hadn’t told me something. Again, she characterized this as a minor issue that they just want to keep an eye on.

So, overall, a pretty good visit. Not 100% perfect news, but mostly very good. Just a few things to watch. And watch, we shall…

Edited to add pictures, finally!
A nice profile of baby girl A, but the shot of baby boy B is kind of Skeletor-esque.

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Categories : Pregnancy, Ultrasounds

Tags : discordant growth, perinatologist

Ultrasound, 17w6d

By Goddess in Progress · Comments (6)· March 29th, 2007

I *love* ultrasounds. Love them, love them, love them.

This is not to say that I didn’t get nervous before my appointment. My husband could barely sleep last night. He was suddenly really anxious. I was doing OK until this morning, when I was just sitting around the house, waiting for 10:00 so we could leave for the hospital. That’s when the butterflies settled in.

It continued to be disconcerting when the woman before us at the perinatologist’s office came out of one of the exam rooms and had clearly been crying. The ultrasound techs were talking in muffled tones. It scared me, because I was again reminded that the rare bad things really do happen to real people. I hoped, yet again, that it wouldn’t be me this time. I hoped the pregnancy karma gods were satisfied with me being one of that 5% of people to lose a pregnancy after seeing the heartbeat. But I wasn’t sure.

The ultrasound itself, though, was great. Our ultrasound tech (Jackie?) was super friendly and informative, telling us what each thing was that she was measuring (femur, abdomen, different parts of the brain, kidneys, etc.). In fact, before she really started, she immediately found both twins and showed us each of their hearts beating. *whew*

Baby A is head-down and weighs approximately 7 ounces. And she’s a girl! The tech was able to discern this pretty quickly, which was great. She was moving around, moving her adorable arms and legs and spine and everything (yes, I drank the magic orange juice before I went in…). Her perfectly-formed four-chambered heart was beating an excellent 145 beats per minute. She’s on the left side of my abdomen.

Baby B is breech and weighs approximately 8 ounces, and due to position and a bout of modesty, did not give us an easy time finding the goods. But eventually we did… and he’s a boy! He kept putting his hand in the way… yes, he really is a boy. He, too, was moving around a lot, giving us a bit more trouble finding his heart and other important things. I ended up having to roll over on my left side (he’s on the right) so she could get a better shot of the heart, which was beating even faster than his sister’s (possibly 180 BPM, but it wasn’t as clear). He’s on the right side.

And, in another very important piece of information, my cervix is closed and nice and long, over 4 centimeters (the goal at this stage is at least over 3 cm). For those who don’t know (though most of you readers are pregnant ladies, so you clearly do know), one of the major risks/indicators for preterm labor is a shortening/effacing or dilating cervix. It’s still quite early, but a very good measurement for right now.

The perinatologist (a wonderful woman who also works at one of the bigger hospitals downtown) came in and talked to us for a little while after the bulk of the scanning was done. She confirmed that everything looked great, which was also nice for her, since she’d had a lot of people with bad news that morning. She gave us some general twin advice (I should start taking an iron supplement so I don’t become severely anemic while these two parasites of mine take whatever they need), and let us know we’ll be in to see her every 3-4 weeks for ultrasounds and growth checks, in addition to my regular OB appointments.

So, all in all, a great day! It was a big sigh of relief to see them both in there, doing great, wiggling around. I haven’t felt them kicking yet (though I believe one has an anterior placenta, so that’ll make it harder to feel for a while), so I don’t get daily reassurance that they’re in there.

And (…drumroll…) the winner of the poll!
While Cynthia and Kathryn both were dead-on accurate with the current combined weights, the all-around winner is:
AMBER (eviswy+1) from Babycenter!
Amber guessed boy/girl with a combined 1lb., 1oz. Only two ounces off, and the correct genders.

Thanks to everyone who voted! It was fun. Well, for me, anyways. I hope you enjoyed stopping by, and feel free to come back anytime you like.

Comments (6)

Categories : Pregnancy, Ultrasounds

Tags : cervical length, gender, level II ultrasound, perinatologist